Surgical instrument



Dec. 11, 1962 R. E. STRAITH SURGICAL INSTRUMENT Filed Jan. 28, 1960 2 Sheets-Sheet l x J 4 J51? a; I

y 4 A A 154 INVENTOR. Z. Jirazl.

Dec. 11, 1962 R. E. STRAITH SURGICAL INSTRUMENT 2 Sheets-Sheet 2 Filed Jan. 28, 1960 Zmz If/sf United States Patent Ofiiice 3,067,748 Patented Dec. 11, 1962 3,067,748 SURGICAL INSTRUMENT Richard E. Straith, 117 Elm Park, Pleasant Ridge, Mich. Filed Jan. 28, 1960, Ser. No. 5,263 19 Claims. (Cl. 128-326) This invention relates generally to a surgical instrument, and more particularly to an instrument for tying ofi severed blood vessels.

Blood vessels severed during the course of a surgical operation are often tied off by gripping the severed end of the blood vessel between the jaws of a hemostat, drawing a ligature about the blood vessel, and weaving the free ends of the ligature into a knot. However, as frequently occurs in surgery of the abdomen, tonsillectomies and the like, blood vessels must be tied off in relatively inaccessible anatomical parts, thereby requiring that the knot be tied blindly.

The surgical instrument of the present invention materially increases the speed and sterility of a surgical operation by tying off such a severed blood vessel in a new and novel manner. The instrument requires the use of only one hand, thereby freeing the other hand of the surgeon for manipulation of the hemostat or to otherwise aid in providing access to the severed blood vessel. Further, the surgical instrument of the present invention does not require the surgeon to insert or work with his hands adjacent the severed blood vessel, thereby permitting the hands of the surgeon to remain exteriorly of the surgical cavity.

Accordingly, one object of the present invention is an improved surgical instrument.

Another object is a surgical knot-tying instrument.

Another object is a surgical knot-tying instrument that is fully operable by one hand.

Another object of the present invention is a surgical knot-tying instrument that is capable of tying a knot to any desired degree of tightness.

Another object is a surgical tying instrument that permits the tying of a surgical knot without the operators hand entering into the surgical cavity.

Other objects and advantages of the present invention will become apparent from the following description wherein reference is made to the drawings, in which:

FIGURE 1 is a front elevational view of an exemplary embodiment of the surgical instrument of the present invention, shown in position preparatory to tying a surgical knot;

FIG. 2 is a side elevational view of the surgical instrument;

FIG. 3. is a front elevational view of the surgical instrument after completion of a knot;

FIG. 4 is a cross-sectional view taken substantially along the line -44 of FIG. 1;

FIG. 5 is a cross-sectional view taken along the line 55 of FIG. 1;

FIG. 6 is a cross-sectional view taken substantially along the line 66 of FIG. 3;

FIG. 7 is a fragmentary side elevation of the surgical instrument, enlarged for clarity; and

FIG. 8 is a fragmentary view of an alternative means of biasing the arms of the instrument to an open position.

A surgical knot-tying instrument 10, in accordance with an exemplary embodiment of the present invention, comprises a handle member 12 having a pair of finger loops 14 and 16 for the acceptance of any two fingers, for example fingers 18 and 20 on a hand 21 of an operator (not shown). The handle member 12 has a vertical central bore 24 therein (FIG. 4) for the acceptance of an upstanding shank 30 on a frame member 32. The shank portion 30 of the frame 32 is rotatable within thebore 24 V in the handle 12 and is restrained from axial movement with respect thereto as by a conventional key Washer 34 that is engaged in a complementary annular slot 36 in the shank 30 of the frame 32. A suitable thrust washer 38 is interposed between an upper end face 39 of the shank 30 and the key washer 34 to provide a relatively large bearing surface therebetween.

A reciprocable tubular shaft 40, having a pair of helical grooves 42 and 44 therein, is disposed within a central bore 46 in the frame member 32. The helical grooves 42 and 44 slidably accept complementary keys or detents 48 and 50 in a rotatable clutch member 52 that is journaled in a bore 51 in the frame member 32. Therefore, movement of the shaft 40 axially with respect to the clutch member 52 effects relative rotation therebetween. Because the shaft 40 is restrained from rotation with respect to the handle 12, as will be discussed, axial movement of the shaft 40 effects rotation of the clutch member 52 with respect to the frame 32.

The lower edge face of the clutch member 52 has a plurality of ratchet teeth 53 thereon, each of which has an axially extending surface 54 and a transverse sloping surface 55. The surfaces 54 and 55 are engageable with complementary surfaces 56 and 57 on a fixed clutch member 58. The fixed clutch member 58 is held within the bore 51 as by a press fit.

The rotatable clutch member 52 is normally biased against the fixed clutch member 58 as by a helical compression spring 59. Upon upward movement of the shaft 40 with respect to the frame member 32, the complementary surfaces 55 and 57 on the clutch members 52 and 58, respectively, coact to permit rotation of the clutch member 52 with respect to the clutch member 58 by camming the clutch member 52 axially upwardly against the spring 59 with a ratcheting action, thereby permitting the shaft 40 to move longitudinally of the bore 46 without effecting rotation of the frame 32. Upon downward movement of the shaft 40 within the bore 46, rotation of the clutch member 52 is transmitted to the clutch member 58 by engagement of the surfaces 54 and 56 thereon, respectively, thereby effecting relative rotation between the shaft '40 and the frame 32.

A thumb yoke 60 comprising a pair of oppositely directed thumb supports 62 and 63 and a downwardly extending tubular portion 64, for the acceptance of an upper end portion 65 of the shaft 40, is secured to the shaft 40, as by welding.

A thumb ring 66 is pivotally supported on a radial arm 68 as by a transverse pin 69. The arm 68 is supported for rotation with respect to the thumb yoke 60 by a transverse pin 70. An end portion 74 of the arm 68 extends into a central cutout portion 76 in the thumb yoke 60 for engagement with an upper end portion 80 of a cam rod 82. The cam rod 82 is disposed within a hollow central portion 84 in the shaft 40 and is slidable axially thereof for a reason to be discussed. It is to be noted that counterclockwise rotation of the arm 68 as seen in FIGURE 2, about the pin 70 effects downward movement of the cam rod 82 due to engagement of the end portion 74 of the arm 68 with the upper end 80 of the cam rod 82. The thumb ring 66 is normally biased to an index-position against a stop on the arm 68 as by a spring 92.

The frame member 32 has a pair of vertically oriented slots and 102 (FIG. 5) on opposite sides of bore 46 therein for acceptance of a pair of downwardly extending arms 104 and 106. The arms 104 and 106 are supported for rotation within the slots 100 and 102 by a pair of transverse arm support pins 108 and 110, respectively, that extend through suitable aligned bores 112 and 114 in the frame member 32. The pins 108 and 110 are retained within the bores 112 and 114 as by a pair of knurled pin retainers 116 and 120. The pins 108 and 110 have radial flanges 122 and 124 there- 3. on, respectively, that, in conjunction With-suitable spring washers 125 and 126, function as clutch surfaces to restrictrotation of a pair of gears 127 and 128. The flanges 122 and 124 are accepted in complementary recesses 1-29 and 130 in the gears 127 and 128..

The pins 108 and 110 have axially split end portions 134 and 135 that are acceptable in the central apertures 136 and 137 of a pair of wire spools 138 and 140. The gears 127 and 128 are provided with index pins 142 "and 144, respectively, that are engageablein complementary apertures 146 and 148 in the spools 138 and 140, respectively, thereby to effect positive rotation of the spools 138 and 140 upon rotation of the gears 127 and 128. It is to be noted that the gears 127 and '128 are meshed for simultaneous opposite rotation for a reason to be discussed.

The downwardly extending arms 104 and 106 have longitudinally extending grooves 160 and 162 in the outer faces 164 and 166 thereof, respectively, for the acceptance and guidance of suitable wires 170 and 172. The wires 170 and 172 are normally coiled on the spools 138 and 140, respectively, and are guided into the grooves 160 and 162 after being unwound from the spools 138 and '140 by a pair of wire guides 174 and 176 that are bent inwardly of the grooves 160 and 162, respectively. The grooves 160 and 162 have crimped portions 180 and 182,

respectively, that positively retain the wires 170 and 172 fectively a continuous wire, opposite ,end portions of which are supported by the arms 104' and 106 andspools 138 and 140, respectively.

A' cam frame 200 is mounted for rotation on alower endportion 202 of the shaft 40 (FIG. 4), The lower end portion 202 of the shaft 40 extendsthrough a bore -'204 -in an upper end wall 206 of the frame 200 and is secured thereto as by a pair of spring retainers208and 210 that are seated in complementary annular grooves 212 and 214 in the end portion 202 of the shaft -40.

A lower end w'all 220 of the camframe 200 has a central bore 222 therein for the acceptanceof a lower end portion 223 of a tubular cam member 224. "The cam member 224 is'slidablefaxially of the'bore 222 and is normally biased downwardly-therein by, a helical compression spring' 226 that extends between the upper end wall20 6 fof the cam frame 200 and a radial flange 228 on the cam member 224. The cam,member 224 'has,a

central bore 230 therein for acceptance or aglower end portion 234fof the cam rod' 82 A'pair of cam fingers 236 and 238- are-mounted for rotation on the oppositesidew'alls 240 and 242 of the cam frame 200 as by a pair of transversely extending pins 244 and 246. The cam fingers 236 and 238 have cam surfaces 248 and 250, respectively, that areengageable with the bottom side of the radial flange 228 on the cam memberp224f Because the cam member 224 is normally biased downwardly, as seen in the drawings, the cam fingers 236 and 238 are normally biasedin thepclockwise and counterclockwise direction, respectively, as seen in FIGURE 0 3.

The cam fingers236 and238 have cam lobes 252 and 254thereon, respectively, that are engageable with the farms 106 and 104, respectively, to normally bias the ,arms 106 and 104 apart. The cam fingers 236 and238 are retainedtin transverse engagement with the arms 106 and 104, respectively, by forked end portions 262 and 264 thereon, respectively.

' Upon axial movement ofthe shaft with respect to 4 the frame 32, the frame 200 and cam fingers 236 and 238 move longitudinally of the arms 104 and 106. Be cause the spring 226 maintains a normal downward bias on the cam member 224, the fingers 236 and 238 normally tend to bias the arms 104 and'106 apart.

As shown in FIG. 8, the arms 104 and 106 may be additionally biased apart as by a spring member 300 having downwardly depending arms 302 and 304. The arms 302 and 304 have threaded bores 306 and 308 therein for the acceptance of a pair of suitably threaded thumbscrews 310 and 312. The'thumb screws 310. and 312. have sharpened points 314 and 316, respectively, that are engageable in suitable ones of a plurality of detents 318 and 320 on the arms 104 and 106, respectively. Because: the opposed pairs of the detents3l8 and 320 are at different distances radially of the pins 108 and 110, respectively, the effective bias of the spring- 300 can be varied by. engaging the pointed end portions 314 and 316 of .the screws 310 and 312 in any desired ones of the detents 318 and 320, respectively. Additionally, the effective bias of the spring 300 can be varied by advancement of the thumb screws 310 and 312.

A wire feedingmechanism 330 (FIG..3) is secured to the cam frame 200 as by a pair of machine screws 332 and 334. The feeding mechanism 330 comprises. abase portion 336, a lower upstanding portion 338, and a finger 340 thatextends generally parallel to the shaft 40. An

upper end portion 342 of the finger 340 is engageable with the gear 128, upon retraction of the shaft 40, to effect rotation of the gear 128. Because the gears 127 and 128 are meshed, rotation of the gear 128 effects, a similar rotationjof the gear 127 in the opposite direction. In this manner, upon each retraction of the shaft 40, the gears 127 and 128 are rotated one angular increment, thereby feeding an increment of wire from the spools 138 and 140.

The surgical instrument 10 of the present invention is prepared for use by initially twisting the end portions 188 and 190 of the wires and 172, respectively, to form the'initial twist 191. As best seen in FIG. 2, a severed end portion 350 of a blood vessel 352 is gripped between the jaws 354 and 3560f a hemostat 358 anddrawn between-the arms 104-and 106 of the instrument 10 so that the initial twist 191 underlies the end portion 350 of the blood vessel 352.

' To accomplish the tying operation,nthe shaft 40 is retracted or moved upwardly as seen in the drawings with respect to the frame 32. This retraction is accomplished "without effecting rotation of the frame 32 and its associated structure due to free-wheelingof the clutch member 52 with respect to the clutch member 58. e The blood vessel 352jis then tied off by biasing the shaft-40 downwardly, as by .the surgeon moving his thumb 22 down- "wardly with respect to his fingers '18 and 20. Due to locking engagement of the clutch members 52 and '58 "upon downward movementof the shaft 40, the frame 32 and arms 104 and 106 are rotated with respect to the handle" portion 12. Rotation of the arms 104 and 106 effects a twisting of the portions 188 and of the wires 170 and 172 to form'a twist 360 onthe opposi-te side of or above the blood vessel 352 (FIG. 3).

Each downward movement of theshaft 40 increases the number of coils in the twist 360. Any desired number of reciprocable movements of theshaft 40 may be effected to give additional turns tothe twists360.

Control of the tension on the portions 188 and 190 of the wires 170 and 172 is-provided so that the surgeon "can control the tightness of the twist 360'formed about ward movement of the cam rod 82, the lower end portion 234 thereof biases the cam member 224 downwardly. Downward movement of the cam member 224 biases the cam fingers 236 and 238 apart through engagement of the radial flange .228 on the cam member 224 with the cam surfaces 248 and 250 on the cam fingers 236 and 238, respectively. Divergence of the cam fingers 236 and 238 biases the arms 106 and 104 apart through the cam lobes 252 and 254. In this manner the surgeon can control the tightness of the knot tied about the blood vessel 352 by controlling tension in the portions 188 and 190.

Upon completion, the twist 360 is preferably cut in half, leaving a plurality of coils to secure the knot about the blood vessel 352 and preparing the instrument for the next knot-tying operation.

While it will be apparent that the embodiments of the invention herein disclosed are well calculated to fulfill the objects of the invention, it will be appreciated that the invention is susceptible to modification, variation and change without departing from the proper scope or fair meaning of the subjoined claims.

What is claimed is:

l. A surgical instrument for tying off a severed blood vessel comprising a handle, a frame rotatable with respect to said handle, means on said frame for supporting the end portions of a wire so as to expose an intermediate portion of the wire for placement on one side of the blood vessel, means on said frame for tensioning the wire, the spacing of said handle, frame and wire sup- .porting means longitudinally of the axis of rotation of said frame being relatively constant, and means for effecting rotation of said frame with respect to said handle to reverse the end portions of said wire with respect to' said intermediate portion thereof to effect a twist in said wire on the side of the blood vessel opposite to said one side.

2. A surgical instrument for tying off a severed blood vessel comprising a handle, a frame rotatable with respect to said handle, means on said frame for supporting the end portions of a wire so as to expose an intermediate portion thereof, the spacing of said handle, frame and wire supporting means longitudinally of the axis of rotationof' said frame being relatively constant,

means for applying tension to said intermediate portion of Wire, and'means for reversing the end portions of said wire with respect to said intermediate portion to effect -a twist in said wire.

3. A surgical instrument for tying off a severed blood vessel comprising a handle, a frame member, supported by and rotatable with respect to said handle, a pair of elongated arms pivotally supported on said frame member for rotation about spaced generally parallel axes, means on said arms for supporting the end portions of a wire so as to expose an intermediate portion thereof, the spacing of said handle, frame and wire supporting means longitudinally of the axis of rotation of said frame being relatively constant, means for tensioning said intermediate portion of wire, and means for rotating said frame member with respect to said handle thereby to rotate one end portion of said wire about the other end portion of said wire to effect a twist in said wire.

4. A surgical instrument for tying off a severed blood vessel comp-rising a handle, grippable by one hand of an operator, means supported by said handle and rotatable with respect thereto for supporting the end portions of a wire so as to expose an intermediate portion thereof for placement on one side of the blood vessel, the spacing of said handle, frame and Wire supporting means longitudinally of the axis of rotation of said frame being relatively constant, and means reciprocable with respect to said handle for rotating said supporting means with respect to the intermediate portion of said wire to effect a twist in said wire on the side of the blood vessel opposite from the one side.

,5. Avsurgical instrument in accordance with claim 4 wherein said reciprocable means is movable with respect to said handle by movement of one digit with respect to another digit on one hand of an operator.

6. A surgical instrument for tying off a severed blood vessel comprising a handle, pair of generally parallel arms supported by said handle and rotatable with respect thereto, said arms including means for supporting the end portions of a wire so as to expose an intermediate portion thereof, the spacing of said handle and Wire supporting means being relatively constant longitudinally of the axis of rotation of said arms upon rotation thereof, means for biasing said arms away from each other to tension said intermediate portion of wire, and means for rotating one end portion of said wire about the other end portion thereof and with respect to said handle to effect a twist in said wire.

7. A surgical instrument for tying off a severed blood vessel comprising a handle, pair of generally parallel arms supported by said handle and rotatable with respect thereto, said arms including means for supporting the end portions of a wire so as to expose an intermediate portion thereof for placement on one side of the blood ,vessel, and means for rotating said arms about a common axis and with respect to said intermediate portion of wire and handle to effect a twist in said wire on the side of the blood vessel opposite from the one side, the spacing of said handle and intermediateportion of wire being maintained relatively constant upon rotation of said arms.

- 8. Asurg'ical instrument for tying off a severed blood vessel comprising handle means, a pair of arms rotatably coupled to said handle at one end, and having means at the other ends thereof, respectively, for supporting the end. portions of a wire so as to expose an intermediate portion of the wire for placement on one side of the blood vessel, the spacing of said handle and intermediate effect a twist in said wire on the side of the blood vessel opposite fromthe one side. I

. 9. A surgical instrument for tying off a severed blood vessel comprising a handle, a pair of generally parallel arms, having means at one end for supporting an end portion of a wire so as to expose an intermediate portion of the wire for placement on one side of the blood vessel, frame means rotatably coupledto said handle for supporting the other end of each of said arms, means restraining said frame from axial movement with respect to said handle, and means for rotating said frame and said arms with respect to said handle about a common axis generally normal to the intermediate portion of said wire to effect a twist in said wire on the side of the blood vessel opposite from the one side.

10. A surgical instrument for tying off a severed blood vessel comprising a pair of arms for supporting the end portions of a wire so as to expose an intermediate portion of the wire for placement on one side of the blood vessel, and means for rotating one end portion of said wire about the other end portion thereof to effect a twist in said wire on the side of the blood vessel opposite from the one side comprising a frame member for the support of said arms having a central bore therein for the acceptance of a reciprocable shaft, said shaft having a helical groove therein, and means within the bore acceptable in said helical groove for effecting rotation of said frame and arms upon movement of said shaft axially of the bore in said frame member.

11. A surgical instrument for tying off a severed blood vessel comprising a handle, a frame member supported by said handle for rotation about a first axis and restrained from axial movement with respect to said handle, a pair of elongated arms on said frame member having opposed end portions for supporting a wire generally normal to said first axis, and means engageable with said fr me memberto effect rotationthereof with respectito said handle to twist said wire. a

12. A surgical instrument for tyingfofit a severedblood vessel comprising a handle, a frame. member supported by said handle" forrotation about a1 first axis, a pair of elongated:arms-supported by said-frame member for rotation about spaced parallel axes generally norrnal to said first axis,means engageable, withsaid frame to effect rotationjthereof with respect to 'said handle, means on said engageable means for, normally biasing said arms apart, and means, on s'aidarms for supporting 'a-wire with a portin' thereof exposed, the spacing-0f the exposed portion of said wire and said handle being relatively constant, longitudinally of the axisof rotation of said frame upon rotation thereof. a

13. A surgical instrument for tying off a severed blood vessel comprising a handle having a central b0re,'a frame member supported for rotation about the "axis of the borein said handle and restrained from axial movement relative to said handle, a pair of elongated arms on said frame extending generally parallel to'the axis ofthe bore in .said handleand supportedfor rotation about spaced axesextending-generally normal tolthe axis of the bore, means reciprocable within the bore in said handle for effecting rotationrofsaid frame member with respect to said handle, means on saidrreciprocable means for normally biasing said armsapart, and means on saidarms for supporting a wire with a portionthereof exposed for placement ,on one side of the severed blood vessel, reciprocation ofsaidv reciprocable means effecting a twist in said wire -on ,the side of the blood vessel oppositefrom the oneside.

14.. Asurgical instrument'for tying off a severedblood vessel comprising .a handle,-a pair of elongatedarms .supported by-said handle for rotation with respectthereto, means on saidarms'for supportinga wire so that an intermediate-portion, of the, wireis. exposed for. placement ..on one side of thersevered .bloodvesseLthe spacinglongitudinallyof'the axis of rotation of said arms of said handle .and intermediate portion jof; wire .b'eing maintained relatively constant upon. rotation 'of the wire p ortion relative vto said, handle means, for, reversing the .end portion of saidwire with respect to the intermediate portion thereof to efiect a twist ,in,said;wire, and. means .operable simultaneously .with said reversing meansf for biasing ,.said arms apart "thereby to tension i the' twisLin said .wire. a

Asurgical instrument. fortyingpif a severedblood 8 vessel comprising a handle having a centralbore and a pair of finger. grips on opposite sides of thebore, a frame member extending into the bore and supported for rotation by said handle about the axis of-the bore therein, said frame member having a bore therein coaxially related to the bore in said handle, a pair of elongated arms on said frame extending generally parallel to the axis of the bore in said handle and supported for rotation about spaced axes extending generally normalto the axis of the bore, an elongated shaft having a helical groove therein reciprocable within the bore in said frame, detent means on saidframe engageable with the helical groove in said shaft for effecting rotation of said frame member with respect to said handle upon axial movement of said shaft in one direction with respect to said handle, means on said shaft for normally biasing said arms apart, selectively operable means on said shaft for supplementing the normal bias on said arms, and means on said arms for supporting a wire with a portion thereof exposed for placement on one side of the severed blood vessel comprising a pair of wire, spools mounted for rotation coaxially with said arms, and a longitudinally extending groove in said arms for guiding said wire.

16.,The instrument of 'claim 15 whereinsaid detent means includes a plurality of ratchet teeth to permit movement of said shaft opposite to said one direction without effecting rotation of said frame member.

17. The instrument-of claim 15 wherein said spools are mounted on 'meshedgears' for simultaneous opposite rotation.

18. The instrument of claim 17 wherein saidshaft includes means engageable with one of said gears'for effecting .a predetermined rotation of each of said gears.

'19. The instrument of' claim 15 wherein saidselectively operable means comprises a thumb yoke on said shaft, a cam rod disposed centrallyofsaid shaft, and .means. cooperable with said. thumb-yokefor biasing said shaftaxially of said shaft to increase thenormal bias on said arms.

References Cited in the file of this patent UNITED STATES PATENTS 468,005 Newitt Feb. 2,' 1892 2,029,904 Williams, Feb.:4, 1936 ..2,737,983 Pray Mar; 13, 195.6

FOREIGN. PATENTS 7 449,582 Germany Sept. 15, 1927 

